What is healthcare in Afghanistan like?

Facilities and Health Information

Well-equipped medical facilities are few and far between throughout Afghanistan. European and American medicines are available in limited quantities and may be expensive or difficult to locate. There is a shortage of basic medical supplies. Basic medicines manufactured in Iran, Pakistan, China, and India are available, but their reliability can be questionable. Several Western-style private clinics have opened in Kabul: the DK-German Medical Diagnostic Center (ph. 079-913-6210), French Children’s Hospital (ph. 020-250-0531), and CURE International Hospital (ph. 079-988-3830) offer a variety of basic and routine-type care but are not always open; if you are seeking treatment you should request U.S. or Western health practitioners.

Afghan public hospitals should be avoided. Individuals without government licenses or even medical degrees often operate private clinics; there is no public agency that monitors their operations. You will not be able to find Western-trained medical personnel in most parts of the country outside Kabul, although there are some international aid groups temporarily providing basic medical assistance in various cities and villages. For any medical treatment, payment is required in advance. Commercial medical evacuation capability from Afghanistan is limited and could take days to arrange. Even medevac companies that claim to serve the world may not agree to come to Afghanistan. If you have medevac insurance, you should confirm with the insurance provider that medevac assistance is available in Afghanistan and which clinics they recommend for evaluation.

You can find detailed information on vaccinations and other health precautions on the Centers for Disease Control's (CDC) website. For information about outbreaks of infectious diseases abroad, consult the World Health Organization (WHO) website. The WHO website also contains additional health information for travelers, including detailed country-specific health information.

Tuberculosis is an increasingly serious health concern in Afghanistan.

Infectious Diseases

The degree of risk is assessed by considering the foreign nature of these infectious diseases, their severity, and the probability of being affected by the diseases present. The diseases listed do not necessarily represent the total disease burden experienced by the local population.

The risk to an individual traveler varies considerably by the specific location, visit duration, type of activities, type of accommodations, time of year, and other factors. Consultation with a travel medicine physician is needed to evaluate individual risk and recommend appropriate preventive measures such as vaccines.

Diseases are organized into the following six exposure categories shown in italics and listed in typical descending order of risk. Note: The sequence of exposure categories listed in individual country entries may vary according to local conditions.

Food or waterborne diseases acquired through eating or drinking on the local economy:

Hepatitis A - a viral disease that interferes with the functioning of the liver; spread through consumption of food or water contaminated with fecal matter, principally in areas of poor sanitation; victims exhibit fever, jaundice, and diarrhea; 15% of victims will experience prolonged symptoms over 6-9 months; vaccine available.

Hepatitis E - a water-borne viral disease that interferes with the functioning of the liver; most commonly spread through fecal contamination of drinking water; victims exhibit jaundice, fatigue, abdominal pain, and dark-colored urine.

Typhoid fever - bacterial disease spread through contact with food or water contaminated by fecal matter or sewage; victims exhibit sustained high fevers; left untreated, mortality rates can reach 20%.

Vectorborne diseases acquired through the bite of an infected arthropod:

Malaria - caused by single-cell parasitic protozoa Plasmodium; transmitted to humans via the bite of the female Anopheles mosquito; parasites multiply in the liver attacking red blood cells resulting in cycles of fever, chills, and sweats accompanied by anemia; death due to damage to vital organs and interruption of blood supply to the brain; endemic in 100, mostly tropical, countries with 90% of cases and the majority of 1.5-2.5 million estimated annual deaths occurring in sub-Saharan Africa.

Dengue fever - mosquito-borne (Aedes aegypti) viral disease associated with urban environments; manifests as sudden onset of fever and severe headache; occasionally produces shock and hemorrhage leading to death in 5% of cases.

Yellow fever - mosquito-borne viral disease; severity ranges from influenza-like symptoms to severe hepatitis and hemorrhagic fever; occurs only in tropical South America and sub-Saharan Africa, where most cases are reported; fatality rate is less than 20%.

Japanese Encephalitis - mosquito-borne (Culex tritaeniorhynchus) viral disease associated with rural areas in Asia; acute encephalitis can progress to paralysis, coma, and death; fatality rates 30%.

African Trypanosomiasis - caused by the parasitic protozoa Trypanosoma; transmitted to humans via the bite of bloodsucking Tsetse flies; infection leads to malaise and irregular fevers and, in advanced cases when the parasites invade the central nervous system, coma, and death; endemic in 36 countries of sub-Saharan Africa; cattle and wild animals act as reservoir hosts for the parasites.

Cutaneous Leishmaniasis - caused by the parasitic protozoa leishmania; transmitted to humans via the bite of sandflies; results in skin lesions that may become chronic; endemic in 88 countries; 90% of cases occur in Iran, Afghanistan, Syria, Saudi Arabia, Brazil, and Peru; wild and domesticated animals, as well as humans, can act as reservoirs of infection.

Plague - a bacterial disease transmitted by fleas normally associated with rats; person-to-person airborne transmission also possible; recent plague epidemics occurred in areas of Asia, Africa, and South America associated with rural areas or small towns and villages; manifests as fever, headache, and painfully swollen lymph nodes; disease progresses rapidly and without antibiotic treatment leads to pneumonic form with a death rate in excess of 50%.

Crimean-Congo hemorrhagic fever - tick-borne viral disease; infection may also result from exposure to infected animal blood or tissue; the geographic distribution includes Africa, Asia, the Middle East, and Eastern Europe; sudden onset of fever, headache, and muscle aches followed by hemorrhaging in the bowels, urine, nose, and gums; the mortality rate is approximately 30%.

Rift Valley fever - a viral disease affecting domesticated animals and humans; transmission is by mosquitoes and other biting insects; infection may also occur through the handling of infected meat or contact with blood; the geographic distribution includes eastern and southern Africa where cattle and sheep are raised; symptoms are generally mild with fever and some liver abnormalities, but the disease may progress to hemorrhagic fever, encephalitis, or ocular disease; fatality rates are low at about 1% of cases.

Chikungunya - mosquito-borne (Aedes aegypti) viral disease associated with urban environments, similar to Dengue Fever; characterized by sudden onset of fever, rash, and severe joint pain usually lasting 3-7 days, some cases result in persistent arthritis.

Water contact diseases acquired through swimming or wading in freshwater lakes, streams, and rivers:

Leptospirosis - a bacterial disease that affects animals and humans; infection occurs through contact with water, food, or soil contaminated by animal urine; symptoms include high fever, severe headache, vomiting, jaundice, and diarrhea; untreated, the disease can result in kidney damage, liver failure, meningitis, or respiratory distress; fatality rates are low but left untreated recovery can take months.

Schistosomiasis - caused by parasitic trematode flatworm Schistosoma; freshwater snails act as intermediate host and release larval form of the parasite that penetrates the skin of people exposed to contaminated water; worms mature and reproduce in the blood vessels, liver, kidneys, and intestines releasing eggs, which become trapped in tissues triggering an immune response; may manifest as an either urinary or intestinal disease resulting in decreased work or learning capacity; mortality, while generally low, may occur in advanced cases usually due to bladder cancer; endemic in 74 developing countries with 80% of infected people living in sub-Saharan Africa; humans act as the reservoir for this parasite.

Aerosolized dust or soil contact disease acquired through inhalation of aerosols contaminated with rodent urine:

Lassa fever - a viral disease carried by rats of the genus Mastomys; endemic in portions of West Africa; infection occurs through direct contact with or consumption of food contaminated by rodent urine or fecal matter containing virus particles; fatality rate can reach 50% in epidemic outbreaks.

Respiratory disease acquired through close contact with an infectious person:

Meningococcal meningitis - bacterial disease, causing inflammation of the lining of the brain and spinal cord; one of the most important bacterial pathogens is Neisseria meningitidis because of its potential to cause epidemics; symptoms include stiff neck, high fever, headaches, and vomiting; bacteria are transmitted from person to person by respiratory droplets and facilitated by close and prolonged contact resulting from crowded living conditions, often with a seasonal distribution; death occurs in 5-15% of cases, typically within 24-48 hours of the onset of symptoms; highest burden of meningococcal disease occurs in the hyperendemic region of sub-Saharan Africa known as the "Meningitis Belt" which stretches from Senegal east to Ethiopia.

Animal contact disease acquired through direct contact with local animals:

Rabies - a viral disease of mammals usually transmitted through the bite of an infected animal, most commonly dogs; virus affects the central nervous system causing brain alteration and death; symptoms initially are non-specific fever and headache progressing to neurological symptoms; death occurs within days of the onset of symptoms.

Drinking Water Source - % of rural population improved

56.1%

Drinking Water Source - % of total population unimproved

35.8%

Drinking Water Source - % of urban population improved

89.9%

HIV/AIDS - adult prevalence rate

0.01%

Hospital Bed Density - beds/1,000 population

.4

Physicians Density - physicians/1,000 population

.19

Diseases - note

Highly pathogenic H5N1 avian influenza has been identified in this country; it poses a negligible risk with extremely rare cases possible among US citizens who have close contact with birds

Sanitation Facility Access - % of total population unimproved

71%

Sanitation Facility Access - % of urban population improved

46.8%

Sanitation Facility Access - % of rural population improved

23.4%

Infectious Diseases - degree of risk

Intermediate

Animal Contact Disease (s)

Rabies

Food or Waterborne Disease (s)

Bacterial diarrhea, hepatitis A, and typhoid fever

Vectorborne Disease (s)

Malaria

Medical Insurance

Uninsured travelers who encounter medical emergencies overseas often face extreme difficulties. Most medical insurance plans do not include coverage outside one's country. Getting medical treatment and hospital care abroad can be very expensive, and, if you need it, a medical evacuation back to your country can cost more than $50,000!

Your local embassy may assist in locating appropriate medical services, informing family or friends, and may even assist in the transfer of funds from back home. But ultimately, payment of hospital and other expenses is entirely your responsibility.

Check the terms of your health insurance policy, whether it’s your own, under your parents' policy, or through your school. If you are not covered while out of the country, you may need to purchase additional coverage. Many travel agents and private companies offer plans that will cover health care expenses overseas including emergency services such as medical evacuations.

Mental Health

Traveling or studying overseas is not a cure for health conditions such as depression or attention deficit disorder. Sometimes going abroad may in fact amplify a condition. One may not have adequate access to prescription medication or mental health facilities. In addition, culture shock, language barriers, and homesickness can deepen isolation or depression.

Before traveling, create a workable plan for managing your mental health while abroad. The availability and quality of mental health services differ widely from country to country. In many countries, one will find it difficult — and sometimes impossible — to find treatment for mental health conditions. With your health services provider or your school, put together a workable mental health plan before you go overseas.

If you have a medical or psychological condition that may require treatment while you are abroad, discuss this ahead of time with your doctor. A vacation or study abroad is a great opportunity to try new things but this is not the time to experiment with not taking your medicine or mixing alcohol with medicine.

Research the social culture of your destination to learn about how mental illnesses are viewed. Attitudes toward mental health can greatly vary between countries.

If you are studying abroad through your university, talk to your university about access to mental health services at overseas programs. Your study abroad office can help you decide what program would be best for you.

If currently receiving mental health services — including prescription medication — find out if those services and/or medication are available at your destination.

Consider the support system you’ll have in place while abroad. If possible, know ahead of time who you can consult about your mental health.

Prescriptions

While you’re abroad is not the time to suddenly realize you ran out of your prescription!

If you have a condition that requires regular medication, bring an extra quantity with you and pack it in your carry-on, just in case your checked luggage gets lost. Just remember to keep it in its original container and clearly labeled — you don’t want to create the impression you’re carrying drugs that haven’t been prescribed to you. In fact, you should check with the local embassy to make sure that your medication is acceptable to carry into the country. Some countries may consider your prescription medication to be illegal. Bring a letter from your doctor listing your medications and explaining why you need them. Doing your research and having a letter can help prevent any misunderstandings along the way.

Bring extras of any medical necessities you need, like contact lenses or glasses. You might want to pack a pair in both your carry-on bag and your checked luggage, just to be safe.

If you have allergies to certain medications, foods, insect bites, or other unique medical problems, consider wearing one of those “medical alert” bracelets and carry a letter from your doctor explaining the required treatment if you become ill. It might not be the coolest piece of jewelry you wear, but it could save your life.

Vaccinations

How important is it to do your research about vaccinations? It might just save your life! Make yourself aware of the different types of vaccinations and which ones you may need to travel to your destination. Schedule an appointment with your doctor at least four to six weeks before you travel to ensure you receive all important shots.

Be sure that you and your family are up to date on your routine vaccinations..

Which vaccinations you need will depend on a number of factors including your destination, whether you will be spending time in rural areas, the season of the year you are traveling, your age, health status, and previous immunizations.